Mrs. Johnson, a 68-year-old patient, presents to the clinic for a routine annual physical exam. She has coverage under a Medicare Advantage Plan. As a medical assistant responsible for billing, what is important to ensure before submitting the claim for the visit?
Automatically submit the claim as all Medicare recipients are entitled to one routine annual physical exam per year without cost-sharing.
Verify Mrs. Johnson's eligibility and coverage for the annual physical exam under her specific Medicare Advantage Plan for the service date.
Assume that the Medicare Advantage Plan follows the same rules as traditional Medicare and requires no verification.
Bill the patient directly for the annual physical, as Medicare Advantage Plans do not cover preventive services.
Medicare Advantage Plans frequently require providers to follow specific guidelines when billing for services. Unlike traditional Medicare, where the annual wellness visit is covered once every 12 months without a copayment or deductible, Medicare Advantage Plans may have different stipulations. The provider must verify the patient's eligibility for the service date to avoid claim rejection. If a provider forgets to verify eligibility and the plan doesn't cover the service at that particular time, the claim could be rejected, leaving the patient or the clinic responsible for the payment.
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